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We are seeking a detail-oriented and experienced Non-Clinical Intake Coordinator III to support the Utilization Management Department in processing health plan referrals for medical services, durable medical equipment, and specialty care.

This position provides administrative support throughout the authorization process to help ensure accurate service determinations, timely communication, proper documentation, and coordination between members, providers, and clinical intake staff. The ideal candidate will have managed care experience, strong data entry skills, knowledge of medical terminology, and experience with ICD and CPT coding.

Essential Duties and Responsibilities

• Screen calls from providers and members regarding the Utilization Management process.
• Obtain referral information from providers and members to support and facilitate the authorization process.
• Serve as a liaison between members, community providers, internal departments, and clinical intake staff.
• Assign diagnostic and procedural codes using ICD-10 and CPT coding classification systems for service requests.
• Request input from clinical intake staff when direction or clinical expertise is needed.
• Review specified referral types using established criteria for pre-authorization of payment.
• Route requests to clinical intake coordinators for approval or auto-authorization when appropriate.
• Interpret benefits and assist with coordination of care for medically necessary services that may not be covered under the health plan, including programs such as CCS and State Waiver Programs.
• Obtain additional medical information for clinical staff to prepare authorizations for review.
• Coordinate health plan services between Utilization Management, Member Services, and Provider Relations.
• Review member history, eligibility, and previous referral authorizations.
• Monitor, track, and process provider service appeals.
• Ensure accurate data entry of authorizations into the QNXT system.
• Act as a resource and support contact for Non-Clinical Intake Coordinator Level I and Level II staff.
• Maintain confidentiality and follow all company policies related to attendance, safety, security, technology use, appearance, and professional conduct.
• Perform other job-related duties as assigned.

Qualifications

Education and Experience:

• High school diploma from an accredited school or equivalent required.
• Medical Assistant associate degree/diploma, Medical Assistant Certificate, or Certified Nurse Assistant certification required.
• Minimum of two years of experience in a managed care setting.
• Minimum of two years of data entry and computer experience.
• Proficiency with ICD-9, ICD-10, and CPT coding procedures.
• Experience with medical terminology required.

Certifications:

• Typing certificate of at least 30 WPM required.

Required Skills

• Strong understanding of referral processing and authorization workflows.
• Knowledge of managed care processes and utilization management.
• Strong data entry accuracy and attention to detail.
• Ability to interpret benefits and coordinate care appropriately.
• Strong communication and customer service skills.
• Ability to work professionally with members, providers, and internal teams.
• Ability to manage multiple priorities independently.
• Strong problem-solving skills with the ability to escalate issues appropriately.
• Ability to maintain accurate and timely documentation.
• Proficiency with computer systems and medical authorization platforms.

Key Performance Expectations

• Manage multiple priorities independently while maintaining strong attendance and dependability.
• Analyze workflow challenges, propose solutions, and escalate concerns when needed.
• Maintain accurate and timely documentation across referral types and specialty areas.
• Support efficient authorization processing and communication.
• Anticipate workflow needs and adjust processes proactively.
• Provide professional support to members, providers, and internal teams.
• Maintain compliance with department standards, confidentiality requirements, and company policies.

Working Conditions

This position is primarily office-based. The employee may be required to move throughout the organization during the workday and must be able to sit for extended periods while working at a computer. This role requires the ability to manage multiple tasks in a fast-paced and changing environment.

Commitment to Diversity: As an equal opportunity employer committed to meeting the needs of a multi-generational and multicultural workforce, Key Staffing recognizes that a diverse staff, reflective of our community, is an integral and welcome part of a successful and ethical business. We hire local talent at all levels regardless of race, color, religion, age, national origin, gender, gender identity, sexual orientation, or disability and actively foster inclusion in all forms both within our company and across interactions with clients, candidates, and partners. 

If this position caught your eye, send us your resume! For best consideration, include the job title and source where you found this position in the subject line of your email to knegrete@hirekeystaff.com